Tobacco use is increasingly prevalent among poor and vulnerable groups and only 4% of recent quitters are abstinent at one year. The concept of "harm reduction" was introduced to address smokers who persist, despite continuing risks. According to the Institute of Medicine, a comprehensive effort to improve public education and communication about harm reduction products should include research and surveillance, and marketing guidelines. Whether smokeless tobacco (ST) can or should be promoted as a "harm reduction" product is a topic of much debate. We have assembled a team to investigate issues surrounding consumer's perceptions of ST consumption as "harm reduction', current ST marketing approaches in use in Ohio Appalachia, and the geographical patterning of these approaches. This R21 application is responsive to PA- 06-361 (Testing Tobacco Products Promoted to Reduce Harm) and will center on ST consumption in Ohio Appalachia, a region characterized by economic disadvantage, lower educational levels, and a high prevalence of ST consumption. The purposes of this investigation are to first, examine ST marketing strategies in rural Ohio Appalachia. This will be accomplished by investigating current marketing to consumers and potential consumers via focus groups (n=160 participants). We will also describe current print marketing materials and other promotional activities and exposures. Finally, we will test the feasibility of a geographical information systems (GIS) methodology to characterize ST marketing patterns to rural adult Appalachians. This will be accomplished by recruiting ST users in three geographically distinct Appalachian counties (n=36 participants) to record activity data and use GPS units to document locations and travel over a one week period. Pro-and anti-tobacco exposures during this time period will be characterized. These findings may assist in predicting future tobacco industry marketing strategies among this vulnerable group. This project should also provide recommendations about how to respond to the increasing focus of the tobacco industry on ST promotion in particular, and "harm reduction" product promotion more generally. PUBLIC HEALTH RELEVANCE: The proposed study examines smokeless tobacco marketing approaches to Ohio Appalachian community residents, a group known to have increased rates of tobacco-attributable diseases. Smokeless tobacco is promoted by the tobacco industry as `reducing harm'or `safe'. We will examine the public's perceptions of smokeless tobacco as a harm reduction product and study advertisements for smokeless tobacco, using a novel geographical information system to establish patterns of marketing approaches.